Provider Demographics
NPI:1609658723
Name:GRAHAM, TANYA BENSON (BSW, MHA, MBA, MA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:BENSON
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:BSW, MHA, MBA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1256 NEWNHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3936
Mailing Address - Country:US
Mailing Address - Phone:803-361-3741
Mailing Address - Fax:803-888-4012
Practice Address - Street 1:1256 NEWNHAM DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3936
Practice Address - Country:US
Practice Address - Phone:803-361-3741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management